The female reproductive system refers to all the female organs that enable a woman to conceive, nurture and deliver a baby. The activity of the female reproductive system is controlled by hormones released by both the brain and the ovaries that cause the development and release of eggs.

Every month from puberty to menopause, an egg is released from one of your ovaries. This is referred to as ovulation and usually occurs in the middle of your cycle. Your cycle is the days from the start of your period to the start of your next period. The egg then survives for around 24 hours during which time it moves into the fallopian tube and awaits fertilization.

In the meantime the lining of the womb has built up ready to accept and nurture the growing embryo. Sperm travel through the neck of the womb, upwards through the uterus and along the fallopian tubes to meet the egg. Once the egg is fertilized by a sperm, an embryo is created and over 4-6 days moves down the fallopian tube to the womb. The embryo then attaches to the lining of the womb and hopefully implanted.

A naturally conceived pregnancy requires ovulation, normal healthy sperm and normal tubes and uterus.

Female fertility can be affected by a woman’s age and common female reproductive conditions such as tubal blockage due to endometriosis or pelvic inflammatory disease, anovulation due to polycystic ovarian syndrome (PCOS) or uterine distortion from submucosal fibroid.

1. Age

Age is the single most important factor influencing a woman’s fertility. This is because the number of eggs you produce rapidly declines as you get older and there is also an increased risk of miscarriage and chromosomal abnormalities.

Once you turn 36, your chance of conceiving naturally is halved compared to your chance at 20 years of age. At the age of 41, this chance falls to just 4%. That’s the success rate for couples per month of trying when the female is aged 41 to 42.

The reason that women in their late 30’s and 40’s have a lower chance of conceiving is that the number of healthy eggs you produce rapidly declines as you get older, especially after the age of 36. The number of eggs available to go through the maturing process will be lower.

As you get older, your cells start to divide abnormally and may distribute unequal amounts of genetic material – causing an increased chance of chromosomal variations. Unfortunately, this means that for older women it’s not just more difficult to fall pregnant, there is also a greater risk of miscarriage, and a higher possibility of having a child with a genetic variation such as Down’s Syndrome.

The good news is that with advances in reproductive technology, including IVF and other forms of assisted conception, you can improve your chances of conceiving and carrying a child.

2. Ovulation Issue and Irregular Period

Women who don’t ovulate often have irregular or no periods. Common causes include PCOS, obesity or low body weight, thyroid dysfunction, premature ovarian failure or low ovarian reserves. Majority of women who have irregular menstruation suffer from PCOS. Treatment will often depend on the cause but may include diet and lifestyle changes or simple fertility drugs to trigger ovulation.

Women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age. Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve.  AMH does not change during menstrual cycle, so the blood sample can be taken at any time of the month – even while you are using oral contraception.

An AMH test gives us some insight into the remaining quantity of eggs and number of fertile years you may have, but it cannot tell us much about the quality of those eggs.